@Article{info:doi/10.2196/mhealth.7088,
author="Killikelly, Clare
and He, Zhimin
and Reeder, Clare
and Wykes, Til",
title="Improving Adherence to Web-Based and Mobile Technologies for People With Psychosis: Systematic Review of New Potential Predictors of Adherence",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="20",
volume="5",
number="7",
pages="e94",
keywords="patient compliance",
keywords="schizophrenia spectrum and other psychotic disorders",
keywords="mobile phone",
keywords="mHealth",
abstract="Background: Despite the boom in new technologically based interventions for people with psychosis, recent studies suggest medium to low rates of adherence to these types of interventions. The benefits will be limited if only a minority of service users adhere and engage; if specific predictors of adherence can be identified then technologies can be adapted to increase the service user benefits. Objective: The study aimed to present a systematic review of rates of adherence, dropout, and approaches to analyzing adherence to newly developed mobile and Web-based interventions for people with psychosis. Specific predictors of adherence were also explored. Methods: Using keywords (Internet or online or Web-based or website or mobile) AND (bipolar disorder or manic depression or manic depressive illness or manic-depressive psychosis or psychosis or schizophr* or psychotic), the following databases were searched: OVID including MedLine, EMBASE and PsychInfo, Pubmed and Web of Science. The objectives and inclusion criteria for suitable studies were defined following PICOS (population: people with psychosis; intervention: mobile or Internet-based technology; comparison group: no comparison group specified; outcomes: measures of adherence; study design: randomized controlled trials (RCT), feasibility studies, and observational studies) criteria. In addition to measurement and analysis of adherence, two theoretically proposed predictors of adherence were examined: (1) level of support from a clinician or researcher throughout the study, and (2) level of service user involvement in the app or intervention development. We provide a narrative synthesis of the findings and followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for reporting systematic reviews. Results: Of the 20 studies that reported a measure of adherence and a rate of dropout, 5 of these conducted statistical analyses to determine predictors of dropout, 6 analyzed the effects of specific adherence predictors (eg, symptom severity or type of technological interface) on the effects of the intervention, 4 administered poststudy feedback questionnaires to assess continued use of the intervention, and 2 studies evaluated the effects of different types of interventions on adherence. Overall, the percentage of participants adhering to interventions ranged from 28-100\% with a mean of 83\%. Adherence was greater in studies with higher levels of social support and service user involvement in the development of the intervention. Studies of shorter duration also had higher rates of adherence. Conclusions: Adherence to mobile and Web-based interventions was robust across most studies. Although 2 studies found specific predictors of nonadherence (male gender and younger age), most did not specifically analyze predictors. The duration of the study may be an important predictor of adherence. Future studies should consider reporting a universal measure of adherence and aim to conduct complex analyses on predictors of adherence such as level of social presence and service user involvement. ",
doi="10.2196/mhealth.7088",
url="http://mhealth.jmir.org/2017/7/e94/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28729235"
}


@Article{info:doi/10.2196/mhealth.7178,
author="Sun, Yunheng
and Jiang, Feng
and Gu, J. Juan
and Wang, Ken Y.
and Hua, Hongwei
and Li, Jing
and Cheng, Zhijun
and Liao, Zhijun
and Huang, Qian
and Hu, Weiwei
and Ding, Gang",
title="Development and Testing of an Intelligent Pain Management System (IPMS) on Mobile Phones Through a Randomized Trial Among Chinese Cancer Patients: A New Approach in Cancer Pain Management",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e108",
keywords="cancer pain",
keywords="intelligent pain management system",
keywords="smart phone",
keywords="intervention",
abstract="Background: Cancer has become increasingly prevalent in China over the past few decades. Among the factors that determine the quality of life of cancer patients, pain has commonly been recognized as a most critical one; it could also lead to the ineffective treatment of the cancer. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS). Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system's usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as ``the Oncology Center''). In a pretest, participants completed a pain management knowledge questionnaire and were evaluated using the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14-day trial period, another round of cancer pain assessment, KPS evaluation and pain management knowledge assessment were repeated. In the trial group, the data were fully automatically collected by the IPMS. In the control group, the data were collected using conventional methods, such as phone interviews or door-to-door visits by physicians. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants successfully completed the trial. First, the feasibility of IPMS by observing the number of daily pain assessments recorded among patients was assessed. Second, the users' satisfaction, effectiveness of pain management, and changes in the quality of their lives were evaluated. All the participants gave high satisfaction score after they used IMPS. Both groups reported similar pain scores and KPS scores at the baseline. At the end of the trial, the mean pain score of the trial group was significantly lower than of the control group (P<.001). The ending KPS score of the trial group was significantly higher than of the control group (P<.001). The improvement of pain management knowledge score in the trial group was more pronounced than that in the control group (P<.001). Conclusions: This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors and to provide real-time supportive intervention on a convenient basis at a low cost. Overall, the IPMS can serve as a reliable and effective approach to control cancer pain and improve quality of life for patients with cancer pain. Trial Registration: Clinicaltrials.gov NCT02765269; http://clinicaltrials.gov/ct2/show/NCT02765269 (Archived by WebCite at?http://www.webcitation.org/6rnwsgDgv) ",
doi="10.2196/mhealth.7178",
url="http://mhealth.jmir.org/2017/7/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743681"
}


@Article{info:doi/10.2196/mhealth.7232,
author="Bae, Kweon Jung
and Vavilin, Andrey
and You, S. Joon
and Kim, Hyeongeun
and Ryu, Young Seon
and Jang, Hun Jeong
and Jung, Woonggyu",
title="Smartphone-Based Endoscope System for Advanced Point-of-Care Diagnostics: Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="27",
volume="5",
number="7",
pages="e99",
keywords="smartphone-based endoscope",
keywords="point-of-care systems",
keywords="mobile health",
keywords="low-resource settings",
abstract="Background: Endoscopic technique is often applied for the diagnosis of diseases affecting internal organs and image-guidance of surgical procedures. Although the endoscope has become an indispensable tool in the clinic, its utility has been limited to medical offices or operating rooms because of the large size of its ancillary devices. In addition, the basic design and imaging capability of the system have remained relatively unchanged for decades. Objective: The objective of this study was to develop a smartphone-based endoscope system capable of advanced endoscopic functionalities in a compact size and at an affordable cost and to demonstrate its feasibility of point-of-care through human subject imaging. Methods: We developed and designed to set up a smartphone-based endoscope system, incorporating a portable light source, relay-lens, custom adapter, and homebuilt Android app. We attached three different types of existing rigid or flexible endoscopic probes to our system and captured the endoscopic images using the homebuilt app. Both smartphone-based endoscope system and commercialized clinical endoscope system were utilized to compare the imaging quality and performance. Connecting the head-mounted display (HMD) wirelessly, the smartphone-based endoscope system could superimpose an endoscopic image to real-world view. Results: A total of 15 volunteers who were accepted into our study were captured using our smartphone-based endoscope system, as well as the commercialized clinical endoscope system. It was found that the imaging performance of our device had acceptable quality compared with that of the conventional endoscope system in the clinical setting. In addition, images captured from the HMD used in the smartphone-based endoscope system improved eye-hand coordination between the manipulating site and the smartphone screen, which in turn reduced spatial disorientation. Conclusions: The performance of our endoscope system was evaluated against a commercial system in routine otolaryngology examinations. We also demonstrated and evaluated the feasibility of conducting endoscopic procedures through a custom HMD. ",
doi="10.2196/mhealth.7232",
url="http://mhealth.jmir.org/2017/7/e99/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28751302"
}


@Article{info:doi/10.2196/mhealth.7346,
author="Bian, Jiang
and Guo, Yi
and Xie, Mengjun
and Parish, E. Alice
and Wardlaw, Isaac
and Brown, Rita
and Modave, Fran{\c{c}}ois
and Zheng, Dong
and Perry, T. Tamara",
title="Exploring the Association Between Self-Reported Asthma Impact and Fitbit-Derived Sleep Quality and Physical Activity Measures in Adolescents",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e105",
keywords="mobile health",
keywords="mHealth",
keywords="asthma",
keywords="Fitbit",
keywords="physical activity",
keywords="sleep",
keywords="sleep quality",
abstract="Background: Smart wearables such as the Fitbit wristband provide the opportunity to monitor patients more comprehensively, to track patients in a fashion that more closely follows the contours of their lives, and to derive a more complete dataset that enables precision medicine. However, the utility and efficacy of using wearable devices to monitor adolescent patients' asthma outcomes have not been established. Objective: The objective of this study was to explore the association between self?reported sleep data, Fitbit sleep and physical activity data, and pediatric asthma impact (PAI). Methods: We conducted an 8?week pilot study with 22 adolescent asthma patients to collect: (1) weekly or biweekly patient?reported data using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of PAI, sleep disturbance (SD), and sleep?related impairment (SRI) and (2) real-time Fitbit (ie, Fitbit Charge HR) data on physical activity (F-AM) and sleep quality (F?SQ). To explore the relationship among the self-reported and Fitbit measures, we computed weekly Pearson correlations among these variables of interest. Results: We have shown that the Fitbit-derived sleep quality F-SQ measure has a moderate correlation with the PROMIS SD score (average r=?.31, P=.01) and a weak but significant correlation with the PROMIS PAI score (average r=?.18, P=.02). The Fitbit physical activity measure has a negligible correlation with PAI (average r=.04, P=.62). Conclusions: Our findings support the potential of using wrist-worn devices to continuously monitor two important factors---physical activity and sleep---associated with patients' asthma outcomes and to develop a personalized asthma management platform. ",
doi="10.2196/mhealth.7346",
url="http://mhealth.jmir.org/2017/7/e105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743679"
}


@Article{info:doi/10.2196/mhealth.6829,
author="H{\"a}lleberg Nyman, Maria
and Frank, Catharina
and Langius-Ekl{\"o}f, Ann
and Blomberg, Karin
and Sundberg, Kay
and Wengstr{\"o}m, Yvonne",
title="Patients' Perspective on Participation in Care With or Without the Support of a Smartphone App During Radiotherapy for Prostate Cancer: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="26",
volume="5",
number="7",
pages="e107",
keywords="patient participation",
keywords="prostate cancer",
keywords="radiotherapy",
keywords="smartphone",
abstract="Background: Patients with prostate cancer are often cared for as outpatients during radiotherapy, which can be an aggravating circumstance for patient participation. There is a need to evaluate whether an interactive smartphone app could enable participation in care, specifically during treatment for prostate cancer. The interactive app (Interaktor) used in this study is developed in codesign with patients and health care professionals; it includes daily reports of symptoms, a risk assessment model, evidence-based self-care advice, along with the provision of immediate access to clinicians. Objective: The aim of this study was to explore how patients with prostate cancer perceived their participation with or without the support of the smartphone app during radiotherapy. Methods: A total of 28 prostate cancer patients receiving adjuvant radiotherapy were interviewed about their perceived participation in their own care. All the patients interviewed in this study participated in an intervention study where the control group received standard care that comprised having access to a contact nurse to turn to with any concerns during their treatment. In addition to standard care, the patients in the intervention group received the app downloaded in a smartphone. The patients' age ranged between 57 and 77 years; 17 patients used the smartphone app. The interviews were analyzed with directed qualitative content analysis. Results: The four dimensions of patient participation, which include mutual participation, fight for participation, requirement for participation, and participation in getting basic needs satisfied, were confirmed as valid perspectives in the interviews with the patients with prostate cancer, irrespective of whether they used the smartphone app. However, the patients who had used the smartphone app described it as a facilitating factor, especially for mutual participation. Conclusions: Using innovative ways to communicate with patients, such as an interactive app for symptom management with contact with health care in real time, can successfully help achieve increased patient participation in care. ",
doi="10.2196/mhealth.6829",
url="http://mhealth.jmir.org/2017/7/e107/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28747294"
}


@Article{info:doi/10.2196/mhealth.7853,
author="Lucero, James Robert
and Frimpong, A. Jemima
and Fehlberg, A. Elizabeth
and Bjarnadottir, I. Ragnhildur
and Weaver, T. Michael
and Cook, Christa
and Modave, Francois
and Rathore, H. Mobeen
and Morano, P. Jamie
and Ibanez, Gladys
and Cook, L. Robert",
title="The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="27",
volume="5",
number="7",
pages="e100",
keywords="telemedicine",
keywords="self-care",
keywords="HIV",
abstract="Background: The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. Objective: This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. Methods: This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. Results: Overall, 85.5\% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8\%) or help to identify relevant health care services (556/745 74.6\%). Age (OR 0.959, 95\% CI 0.936-0.982), education (OR 1.281, 95\% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95\% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. Conclusions: This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management. ",
doi="10.2196/mhealth.7853",
url="http://mhealth.jmir.org/2017/7/e100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28751298"
}


@Article{info:doi/10.2196/mhealth.7410,
author="West, H. Joshua
and Belvedere, M. Lindsay
and Andreasen, Rebecca
and Frandsen, Christine
and Hall, Cougar P.
and Crookston, T. Benjamin",
title="Controlling Your ``App''etite: How Diet and Nutrition-Related Mobile Apps Lead to Behavior Change",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="10",
volume="5",
number="7",
pages="e95",
keywords="diet",
keywords="nutritional status",
keywords="mobile apps",
keywords="behavior and behavior mechanisms",
abstract="Background: In recent years, obesity has become a serious public health crisis in the United States. Although the problem of obesity is being addressed through a variety of strategies, the use of mobile apps is a relatively new development that could prove useful in helping people to develop healthy dietary habits. Though such apps might lead to health behavior change, especially when relevant behavior change theory constructs are integrated into them, the mechanisms by which these apps facilitate behavior change are largely unknown. Objective: The purpose of this study was to identify which behavior change mechanisms are associated with the use of diet- and nutrition-related health apps and whether the use of diet- and nutrition-related apps is associated with health behavior change. Methods: A cross-sectional survey was administered to a total of 217 participants. Participants responded to questions on demographics, use of diet and nutrition apps in the past 6 months, engagement and likability of apps, and changes in the participant's dietary behaviors. Regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potential confounding variables. Results: The majority of study participants agreed or strongly agreed with statements regarding app use increasing their motivation to eat a healthy diet, improving their self-efficacy, and increasing their desire to set and achieve health diet goals. Additionally, majority of participants strongly agreed that using diet/nutrition apps led to changes in their behavior, namely increases in actual goal setting to eat a healthy diet (58.5\%, 127/217), increases in their frequency of eating healthy foods (57.6\%, 125/217), and increases in their consistency of eating healthy foods (54.4\%, 118/217). Participants also responded favorably to questions related to engagement and likability of diet/nutrition apps. A number of predictors were also positively associated with diet-related behavior change. Theory (P<.001), app engagement (P<.001), app use (P<.003), and education (P<.010) were all positively associated with behavior change. Conclusions: Study findings indicate that the use of diet/nutrition apps is associated with diet-related behavior change. Hence, diet- and nutrition-related apps that focus on improving motivation, desire, self-efficacy, attitudes, knowledge, and goal setting may be particularly useful. As the number of diet- and nutrition-related apps continues to grow, developers should consider integrating appropriate theoretical constructs for health behavior change into the newly developed mobile apps. ",
doi="10.2196/mhealth.7410",
url="http://mhealth.jmir.org/2017/7/e95/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28694241"
}


@Article{info:doi/10.2196/mhealth.8231,
author="Brinker, Josef Titus
and Schadendorf, Dirk
and Klode, Joachim
and Cosgarea, Ioana
and R{\"o}sch, Alexander
and Jansen, Philipp
and Stoffels, Ingo
and Izar, Benjamin",
title="Photoaging Mobile Apps as a Novel Opportunity for Melanoma Prevention: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="26",
volume="5",
number="7",
pages="e101",
keywords="melanoma",
keywords="skin cancer",
keywords="prevention",
keywords="mobile apps",
keywords="smartphones",
keywords="photoaging",
abstract="Background: Around 90\% of melanomas are caused by ultraviolet (UV) exposure and are therefore eminently preventable. Unhealthy tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to skin atrophy and malignant melanoma are too far in the future to fathom. Photoaging desktop programs, in which an image is altered to predict future appearance, have been successful in positively influencing behavior in adiposity or tobacco prevention settings. Objective: To develop and test a photoaging app designed for melanoma prevention. Methods: We harnessed the widespread availability of mobile phones and adolescents' interest in appearance to develop a free mobile app called Sunface. This app has the user take a self-portrait (ie, a selfie), and then photoages the image based on Fitzpatrick skin type and individual UV protection behavior. Afterward, the app explains the visual results and aims at increasing self-competence on skin cancer prevention by providing guideline recommendations on sun protection and the ABCDE rule for melanoma self-detection. The underlying aging algorithms are based on publications showing UV-induced skin damage by outdoor as well as indoor tanning. To get a first impression on how well the app would be received in a young target group, we included a total sample of 25 students in our cross-sectional pilot study with a median age of 22 (range 19-25) years of both sexes (11/25, 44\% female; 14/25, 56\% male) attending the University of Essen in Germany. Results: The majority of enrolled students stated that they would download the app (22/25, 88\%), that the intervention had the potential to motivate them to use sun protection (23/25, 92\%) and that they thought such an app could change their perceptions that tanning makes you attractive (19/25, 76\%). Only a minority of students disagreed or fully disagreed that they would download such an app (2/25, 8\%) or that such an app could change their perceptions on tanning and attractiveness (4/25, 16\%). Conclusions: Based on previous studies and the initial study results presented here, it is reasonable to speculate that the app may induce behavioral change in the target population. Further work is required to implement and examine the effectiveness of app-based photoaging interventions within risk groups from various cultural backgrounds. ",
doi="10.2196/mhealth.8231",
url="http://mhealth.jmir.org/2017/7/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28747297"
}


@Article{info:doi/10.2196/mhealth.7420,
author="Desteghe, Lien
and Kluts, Kiki
and Vijgen, Johan
and Koopman, Pieter
and Dilling-Boer, Dagmara
and Schurmans, Joris
and Dendale, Paul
and Heidbuchel, Hein",
title="The Health Buddies App as a Novel Tool to Improve Adherence and Knowledge in Atrial Fibrillation Patients: A Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="19",
volume="5",
number="7",
pages="e98",
keywords="mHealth",
keywords="anticoagulants",
keywords="medication adherence",
keywords="education",
keywords="atrial fibrillation",
abstract="Background: Atrial fibrillation (AF) constitutes an important risk for stroke, especially in an ageing population. A new app (Health Buddies) was developed as a tool to improve adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in an elderly AF population by providing a virtual contract with their grandchildren, spelling out daily challenges for both. Objective: The aim of this pilot study was to assess the feasibility and usability of the Health Buddies app in AF patients. Methods: Two workshops were conducted to steer app development and to test a first prototype. The feasibility of the finalized app was investigated by assessing the number of eligible AF patients (based on current prescription of NOACs, the presence of grandchildren between 5 and 15 years old, availability of a mobile phone, computer, or tablet), and the proportion of those who were willing to participate. Participants had to use the app for 3 months. The motivation of the patients to use the app was assessed based on the number of logins to the app. Their perception of its usefulness was examined by specific questionnaires. Additionally, the effects on knowledge level about AF and its treatment, and adherence to NOAC intake were investigated. Results: Out of 830 screened AF patients, 410 were taking NOACs and 114 were eligible for inclusion. However, only 3.7\% (15/410) of the total NOAC population or 13.2\% of the eligible patients (15/114) were willing to participate. The main reasons for not participating were no interest to participate in general or in the concept in particular (29/99, 29\%), not feeling comfortable using technology (22/99, 22\%), no interest by the grandchildren or their parents (20/99, 20\%), or too busy a lifestyle (12/99, 12\%). App use significantly decreased towards the end of the study period in both patients (P=.009) and grandchildren (P<.001). NOAC adherence showed a taking adherence and regimen adherence of 88.6\% (SD 15.4) and 81.8\% (SD 18.7), respectively. Knowledge level increased from 64.6\% (SD 14.7) to 70.4\% (SD 10.4) after 3 months (P=.09). The app scored positively on clarity, novelty, stimulation, and attractiveness as measured with the user experience questionnaire. Patients evaluated the educational aspect of this app as a capital gain. Conclusions: Only a small proportion of the current AF population seems eligible for the innovative Health Buddies app in its current form. Although the app was positively rated by its users, a large subset of patients was not willing to participate in this study or to use the app. Efforts have to be made to expand the target group in the future. ",
doi="10.2196/mhealth.7420",
url="http://mhealth.jmir.org/2017/7/e98/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28724512"
}


@Article{info:doi/10.2196/mhealth.7938,
author="Ichikawa, Daisuke
and Kashiyama, Makiko
and Ueno, Taro",
title="Tamper-Resistant Mobile Health Using Blockchain Technology",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="26",
volume="5",
number="7",
pages="e111",
keywords="telemedicine",
keywords="electronic health records",
keywords="sleep",
keywords="cognitive therapy",
keywords="computer security",
abstract="Background: Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials. Objective: The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network. Methods: We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults. Results: Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network. Conclusions: Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization. ",
doi="10.2196/mhealth.7938",
url="http://mhealth.jmir.org/2017/7/e111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28747296"
}


@Article{info:doi/10.2196/mhealth.7462,
author="Cheng, Feng
and Xu, Junfang
and Su, Chunyan
and Fu, Xiaoxing
and Bricker, Jonathan",
title="Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="11",
volume="5",
number="7",
pages="e93",
keywords="smoking cessation",
keywords="smartphone apps",
keywords="China",
abstract="Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China. ",
doi="10.2196/mhealth.7462",
url="http://mhealth.jmir.org/2017/7/e93/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28698170"
}


@Article{info:doi/10.2196/mhealth.7871,
author="Rahman, Abidur Quazi
and Janmohamed, Tahir
and Pirbaglou, Meysam
and Ritvo, Paul
and Heffernan, M. Jane
and Clarke, Hance
and Katz, Joel",
title="Patterns of User Engagement With the Mobile App, Manage My Pain: Results of a Data Mining Investigation",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="12",
volume="5",
number="7",
pages="e96",
keywords="chronic pain",
keywords="mhealth",
keywords="opioid use",
keywords="data mining",
keywords="cluster analysis",
keywords="Manage My Pain",
keywords="pain management",
keywords="pain app",
abstract="Background: Pain is one of the most prevalent health-related concerns and is among the top 3 most common reasons for seeking medical help. Scientific publications of data collected from pain tracking and monitoring apps are important to help consumers and healthcare professionals select the right app for their use. Objective: The main objectives of this paper were to (1) discover user engagement patterns of the pain management app, Manage My Pain, using data mining methods; and (2) identify the association between several attributes characterizing individual users and their levels of engagement. Methods: User engagement was defined by 2 key features of the app: longevity (number of days between the first and last pain record) and number of records. Users were divided into 5 user engagement clusters employing the k-means clustering algorithm. Each cluster was characterized by 6 attributes: gender, age, number of pain conditions, number of medications, pain severity, and opioid use. Z tests and chi-square tests were used for analyzing categorical attributes. Effects of gender and cluster on numerical attributes were analyzed using 2-way analysis of variances (ANOVAs) followed up by pairwise comparisons using Tukey honest significant difference (HSD). Results: The clustering process produced 5 clusters representing different levels of user engagement. The proportion of males and females was significantly different in 4 of the 5 clusters (all P ?.03). The proportion of males was higher than females in users with relatively high longevity. Mean ages of users in 2 clusters with high longevity were higher than users from other 3 clusters (all P <.001). Overall, males were significantly older than females (P <.001). Across clusters, females reported more pain conditions than males (all P <.001). Users from highly engaged clusters reported taking more medication than less engaged users (all P <.001). Females reported taking a greater number of medications than males (P =.04). In 4 of 5 clusters, the percentage of males taking an opioid was significantly greater (all P ?.05) than that of females. The proportion of males with mild pain was significantly higher than that of females in 3 clusters (all P ?.008). Conclusions: Although most users of the app reported being female, male users were more likely to be highly engaged in the app. Users in the most engaged clusters self-reported a higher number of pain conditions, a higher number of current medications, and a higher incidence of opioid usage. The high engagement by males in these clusters does not appear to be driven by pain severity which may, in part, be the case for females. Use of a mobile pain app may be relatively more attractive to highly-engaged males than highly-engaged females, and to those with relatively more complex chronic pain problems. ",
doi="10.2196/mhealth.7871",
url="http://mhealth.jmir.org/2017/7/e96/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28701291"
}


@Article{info:doi/10.2196/mhealth.7335,
author="Dicianno, Edward Brad
and Henderson, Geoffrey
and Parmanto, Bambang",
title="Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="24",
volume="5",
number="7",
pages="e103",
keywords="goals",
keywords="self-care",
keywords="mobile health",
keywords="rehabilitation",
keywords="smartphone",
keywords="spinal cord injury",
keywords="spinal dysraphism",
abstract="Background: Goal-setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to (1) qualitatively analyze data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module to support their complex goal-setting routines, (2) design a prototype of a goal-setting module within an existing mobile health (mHealth) system, and (3) identify what educational content might be necessary to integrate into the system. Methods: A total of 750 goals were analyzed from patients with SB and SCI enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for an mHealth goal-setting module and identify important educational content. Results: Those of male sex (P=.02) and with SCI diagnosis (P<.001) were more likely to achieve goals than females or those with SB. Temporality (P<.001) and type (P<.001) of goal were associated with likelihood that the goal would be achieved. Nearly all (210/213; 98.6\%) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated. Conclusions: Innovative mHealth tools can be developed to support commonly set goals by individuals with disabilities. ",
doi="10.2196/mhealth.7335",
url="http://mhealth.jmir.org/2017/7/e103/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28739558"
}


@Article{info:doi/10.2196/mhealth.7208,
author="Weenk, Mariska
and van Goor, Harry
and Frietman, Bas
and Engelen, JLPG Lucien
and van Laarhoven, JHM Cornelis
and Smit, Jan
and Bredie, JH Sebastian
and van de Belt, H. Tom",
title="Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="05",
volume="5",
number="7",
pages="e91",
keywords="remote sensing technology",
keywords="vital signs",
keywords="wireless technology",
keywords="continuous monitoring",
abstract="Background: Measurement of vital signs in hospitalized patients is necessary to assess the clinical situation of the patient. Early warning scores (EWS), such as the modified early warning score (MEWS), are generally calculated 3 times a day, but these may not capture early deterioration. A delay in diagnosing deterioration is associated with increased mortality. Continuous monitoring with wearable devices might detect clinical deterioration at an earlier stage, which allows clinicians to take corrective actions. Objective: In this pilot study, the feasibility of continuous monitoring using the ViSi Mobile (VM; Sotera Wireless) and HealthPatch (HP; Vital Connect) was tested, and the experiences of patients and nurses were collected. Methods: In this feasibility study, 20 patients at the internal medicine and surgical ward were monitored with VM and HP simultaneously for 2 to 3 days. Technical problems were analyzed. Vital sign measurements by nurses were taken as reference and compared with vital signs measured by both devices. Patient and nurse experiences were obtained by semistructured interviews. Results: In total, 86 out of 120 MEWS measurements were used for the analysis. Vital sign measurements by VM and HP were generally consistent with nurse measurements. In 15\% (N=13) and 27\% (N=23) of the VM and HP cases respectively, clinically relevant differences in MEWS were found based on inconsistent respiratory rate registrations. Connection failure was recognized as a predominant VM artifact (70\%). Over 50\% of all HP artifacts had an unknown cause, were self-limiting, and never took longer than 1 hour. The majority of patients, relatives, and nurses were positive about VM and HP. Conclusions: Both VM and HP are promising for continuously monitoring vital signs in hospitalized patients, if the frequency and duration of artifacts are reduced. The devices were well received and comfortable for most patients. ",
doi="10.2196/mhealth.7208",
url="http://mhealth.jmir.org/2017/7/e91/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28679490"
}


@Article{info:doi/10.2196/mhealth.7399,
author="Leonard, Regina Noelle
and Silverman, Michelle
and Sherpa, Phuti Dawa
and Naegle, A. Madeline
and Kim, Hyorim
and Coffman, L. Donna
and Ferdschneider, Marcy",
title="Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="07",
volume="5",
number="7",
pages="e90",
keywords="wearable sensors",
keywords="ecological momentary intervention",
keywords="college students",
keywords="alcohol use",
keywords="feasibility studies",
keywords="acceptability studies",
abstract="Background: An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors. Objective: The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband. Methods: We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test--Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected. Results: Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7\% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified. Conclusions: Delivering intervention material ``just-in-time,'' at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies. ",
doi="10.2196/mhealth.7399",
url="http://mhealth.jmir.org/2017/7/e90/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28687533"
}


@Article{info:doi/10.2196/mhealth.7437,
author="Parak, Jakub
and Uuskoski, Maria
and Machek, Jan
and Korhonen, Ilkka",
title="Estimating Heart Rate, Energy Expenditure, and Physical Performance With a Wrist Photoplethysmographic Device During Running",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e97",
keywords="fitness trackers",
keywords="photoplethysmography",
keywords="heart rate",
keywords="heart rate determination",
keywords="exercise test",
keywords="oxygen consumption",
keywords="energy metabolism",
abstract="Background: Wearable sensors enable long-term monitoring of health and wellbeing indicators. An objective evaluation of sensors' accuracy is important, especially for their use in health care. Objective: The aim of this study was to use a wrist-worn optical heart rate (OHR) device to estimate heart rate (HR), energy expenditure (EE), and maximal oxygen intake capacity (VO2Max) during running and to evaluate the accuracy of the estimated parameters (HR, EE, and VO2Max) against golden reference methods. Methods: A total of 24 healthy volunteers, of whom 11 were female, with a mean age of 36.2 years (SD 8.2 years) participated in a submaximal self-paced outdoor running test and maximal voluntary exercise test in a sports laboratory. OHR was monitored with a PulseOn wrist-worn photoplethysmographic device and the running speed with a phone GPS sensor. A physiological model based on HR, running speed, and personal characteristics (age, gender, weight, and height) was used to estimate EE during the maximal voluntary exercise test and VO2Max during the submaximal outdoor running test. ECG-based HR and respiratory gas analysis based estimates were used as golden references. Results: OHR was able to measure HR during running with a 1.9\% mean absolute percentage error (MAPE). VO2Max estimated during the submaximal outdoor running test was closely similar to the sports laboratory estimate (MAPE 5.2\%). The energy expenditure estimate (n=23) was quite accurate when HR was above the aerobic threshold (MAPE 6.7\%), but MAPE increased to 16.5\% during a lighter intensity of exercise. Conclusions: The results suggest that wrist-worn OHR may accurately estimate HR during running up to maximal HR. When combined with physiological modeling, wrist-worn OHR may be used for an estimation of EE, especially during higher intensity running, and VO2Max, even during submaximal self-paced outdoor recreational running. ",
doi="10.2196/mhealth.7437",
url="http://mhealth.jmir.org/2017/7/e97/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743682"
}


@Article{info:doi/10.2196/mhealth.7647,
author="Gaudet, Jeffrey
and Gallant, Fran{\c{c}}ois
and B{\'e}langer, Mathieu",
title="A Bit of Fit: Minimalist Intervention in Adolescents Based on a Physical Activity Tracker",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="06",
volume="5",
number="7",
pages="e92",
keywords="health behavior",
keywords="health promotion",
keywords="mHealth",
keywords="physical activity tracker",
abstract="Background: Only 5\% of Canadian youth meet the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day, with leisure time being increasingly allocated to technology usage. Direct-to-consumer mHealth devices that promote physical activity, such as wrist-worn physical activity trackers, have features with potential appeal to youth. Objective: The primary purpose of this study was to determine whether a minimalist physical activity tracker-based intervention would lead to an increase in physical activity in young adolescents. A secondary aim of this study was to assess change in physical activity across a 7-week intervention, as measured by the tracker. Methods: Using a quasi-experimental crossover design, two groups of 23 young adolescents (aged 13-14 years) were randomly assigned to immediate intervention or delayed intervention. The intervention consisted of wearing a Fitbit-Charge-HR physical activity tracker over a 7-week period. Actical accelerometers were used to measure participants' levels of MVPA before and at the end of intervention periods for each group. Covariates such as age, sex, stage of change for physical activity behavior, and goal commitment were also measured. Results: There was an increase in physical activity over the course of the study period, though it was not related to overall physical activity tracker use. An intervention response did, however, occur in a subset of participants. Specifically, exposure to the physical activity tracker was associated with an average daily increase in MVPA by more than 15 minutes (P=.01) among participants who reported being in the action and maintenance stages of behavior change in relation to participation in physical activity. Participants in the precontemplation, contemplation, and preparation stages of behavior change had no change in their level of MVPA (P=.81). Conclusions: These results suggest that physical activity trackers may elicit improved physical activity related behavior in young adolescents demonstrating a readiness to be active. Future studies should seek to investigate if integrating physical activity trackers as part of more intensive interventions leads to greater increases in physical activity across different levels of stages of behavior change and if these changes can be sustained over longer periods of time. ",
doi="10.2196/mhealth.7647",
url="http://mhealth.jmir.org/2017/7/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28684384"
}